Should I give my child a pacifier?

Should I give my child a pacifier?

[mme_highlight] The pacifier should be offered to babies, but only after the breastfeeding is correctly established and its use must be limited to the first twenty four months of life. The pacifier, if correctly used, promotes well-being and gives babies a sense of comfort. [mme_highlight]

The question of giving a pacifier to a child is not a consensual one, not only among parents but also among health care providers. In many cases, using a pacifier soothes a baby, but parents are often afraid that a pacifier can impair breastfeeding, cause dental caries or deformations in children’s teeth.  Nevertheless, many pediatricians often refer the benefits of using a pacifier, including its role in the prevention of the Infant Sudden Death Syndrome.

Definitions and statistics

Since ancestral eras, pacifiers have been used, even if not in the same format as we see them today – there is evidence of their existence dating from 3000 years ago. It is estimated that nowadays, in the developed countries, the percentage of utilization of pacifiers is between 75 to 79%.

In babies, suction is a reflex, which means it is done in an involuntary way. It is present since the intrauterine life through the first to third years of life.

There are two types of suction: nutritive suction (present in breastfeeding) and non nutritive suction (like in finger suction or with pacifiers).

Can I give my child a pacifier even if I am breastfeeding?

The benefits of breastfeeding are widely known and it is recommended as the only nutritional source during the first six months of life. As the suction movement is different during breastfeeding from that with a pacifier, many parents fear that the baby can confuse both or that a baby using a pacifier does not want so many breastfeeds leading to a decrease in milk production. However, many scientific studies conclude there is no interference and pediatricians recommend offering a pacifier after breastfeeding is already established.

Can the use of a pacifier prevent the Infant Sudden Death Syndrome?

The American Association of Pediatrics recommends the use of a pacifier to prevent Infant Sudden Death Syndrome during the first year of life, after breastfeeding is fully established; however, parents should not force their babies to have a pacifier if they refuse it. In addition, the pacifier should not be put back in baby’s mouth after falling in the floor or if dropped during sleep. The pacifier should not be linked to clothes by other objects, as there is an asphyxiation risk.

[mme_databox]
Reduction of Incidence of Infant Sudden Death Syndrome with the use of a Pacifier

  • About 30% reduction if used regularly (OR 0.71 with CI 0.59-0.85)
  • About 60% reduction when used during last sleep (OR 0.39 with CI 0.31-0.50)
  • About 17% reduction when regularly used during sleep (OR 0.39 with CI 0.31 a 0.50)

OR – Odds Ratio; CI – Confidence Interval
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Does a pacifier cause damage or caries in my child’s mouth?

The pacifier occupies the oral cavity and, overtime, it can produce changes in its development.

The majority of scientific studies conclude that the consequences are more important in children who continue using pacifiers after twenty four months of age. The later the pacifier is left, the higher the probability of these consequences in the teeth arcades.

Regarding caries, the Canadian Society of Pediatrics states that the appearance of caries can be associated only with a continued use of a pacifier past 5 years of age or with its utilization in association with sugar solutions.

What other benefits do pacifiers have?

It is nowadays acknowledged that a pacifier can relief pain in neonates and babies during painful procedures (like vaccines, punctions, test for rethynopathy of prematurity), thus a pacifier should be offered in these moments. This relief effect can be explained by the release of pain relieving substances (like serotonin) during the suction. In these situations, the relief of pain can be greater if a sugar solution is used with the pacifier.

[mme_databox]
Reduction of Crying Time with the use of a Pacifier

(study of the use of pacifiers for infants venipuncture in a pediatric emergency department)

  • 0-1 month infants: reduction of 52 seconds
  • 1-3 month infants: reduction of 123.9 seconds

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Is there any health problem related with the use of pacifiers?

Some studies have concluded that not using a pacifier can decrease about 29% the recurrence of an ear infection (acute otitis), which means that not using a pacifier decreases the odds for an ear infection to appear again. This conclusion lead to the recommendation that in children with history of ear infection, it may be prudent not to use a pacifier as it is a risk factor for recurrence of the infection.

Summary

  • The pacifier should be offered to babies, but only after the breastfeeding is correctly established, which happens around the first month of life.
  • Prefer to offer the pacifier during the main sleeping period of the child.
  • Do not use objects to hold the pacifier to the child’s clothes, as there is a risk of asphyxiation.
  • Do not offer your child a pacifier that has fallen in the ground.
  • Careful consider not offering a pacifier to a child that is prone to ear infections.
  • The use of a pacifier must be limited to the first twenty four months of life, since after this age its use raises the likelihood for dental caries and alterations in teeth structure.
  • Pacifiers should be offered during painful procedures, as they promote the release of pain relieving substances.
  • The pacifier, if correctly used, promotes well-being and gives babies a sense of comfort.

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References

  • Sexton S, Natale R. Risks and benefits of pacifiers. American Family Physician. 2009
  • Richard H. Schvartz, MD, Infant Pacifiers: An Overview. May 2008
  • M Ponti. Recommendations for the use of pacifiers. Canadian Paediatric Society. Paediatr Child Health 2003;8(8):515-9 2003
  • Niemelä M, Pihakari O, Pokka T, Uhari M. Pacifier as a risk factor for otitis media: randomized, controlled trial of parental counseling. Pediatrics. 2000;106:483-8.
  • Hauck, F. R., Omojokun, O. O., & Siadaty, M. S. (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116, e716–e723.
  • Mitchell, E. A., Blair, P. S., & L’Hoir, M. P. (2006). Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics. 2006 May;117(5):1755-8.
  • SJ, Jou H, Ali S, Vandermeer B, Klassen T. A randomized controlled trial of sucrose and/or pacifier as analgesia for infants venipuncture in a pediatric emergency department. BMC Pediatr. 2007;7:27.

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